Aerosol therapy practices in Spanish PICUs: A nationwide survey on device use and clinical variability

Aerosol therapy in critically ill pediatric patients is challenging due to the interaction between delivery devices and respiratory support systems such as high-flow nasal cannula (HFNC), non invasive ventilation (NIV), and conventional mechanical ventilation (CMV). Limited evidence leads to heterogeneity in practice. This study aimed to describe aerosol delivery practices in Spanish pediatric intensive care units (PICUs) and assess the need for consensus guidelines.

We conducted a cross-sectional descriptive observational study through an anonymous, face-validated, pilot-tested electronic survey distributed to members of the Spanish Society of Pediatric Intensive Care (SECIP). The survey, open from April 15 to September 15, 2024, explored technical aspects of aerosol therapy in patients under different respiratory supports.

72 SECIP members completed the survey: 82 % worked in tertiary hospitals and 94.4 % in PICUs. Device use included vibratory mesh nebulizers (VM, 91.7 %), jet nebulizers (JN, 62.5 %), and pressure metered dose inhalers with spacers (pMDI, 51.4 %). 70.8 % aerosolized during HFNC with the three different devices: 31.9 % and 18.1 % removed the nasal cannula when using pMDI and JN, respectively; 69.1 % slowed down HFNC flow when using VM in line, with varying placement of VM devices in the circuit. In NIV single-limb circuits, 41.7 % placed devices between the exhalation valve and interface. In CMV, 96 % maintained humidification; incorrect placement of VM was more frequent in clinicians with <5 years (38.5 %) and >20 years of experience (50 %). All participants highlighted the need for guidelines.

Significant variability exists in aerosol therapy practices across Spanish PICUs, frequently diverging from literature recommendations. Consensus-based guidelines, reinforced by education and research, are required to optimize aerosol delivery in critically ill pediatric patients.